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“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact” ~ Charles Darwin (it's evolutionary baybeee!)

Thursday, March 31, 2011

Fasting Insulin & Weight Loss

Some folks have been having a bit of a go at me over at Peter/Hyperlipid's blog. I guess it all started by Peter taking some sort of offense to my post on his Potatoes and weight loss post entitled Insulin Caused Cerebral Stress. My intent with my post was not to mock Peter. It was to point out how so inconsistent with observations the carb/insulin hypothesis is, so as to elicit elaborate explanations such as the scenario Peter described to explain a simple phenomenon: Voight lost weight eating potatoes by estimating his energy needs and eating a controlled amount of predominantly potato-derived calories. Peter, himself, started that post discussing the time/pages he had spent developing his theory. I don't question/contest that what he says regarding insulin, sensitivity, etc. may actually be true. I do believe, however, it is irrelevant. I say that because I just do not see consistent evidence to support his assertion that:

My point was that, there was a much simpler explanation for why Voight lost weight: He expended more calories than he took in. Why? Well, likely because Voight monitored his intake. Perhaps he underestimated maintenance levels, maybe potatoes make him hyper and increase NEAT, maybe he has digestive issues and didn't absorb all his potato-derived calories. Who knows? But my premise is that:

The ultimate determinant of weight loss is being in energy deficit. ~Penelope Jones

Therefore when someone loses weight eating potatoes or cream cheese, Twinkies or beef & coconut oil, I do not have to do any mental gymnastics to "wrap my head around" the results. Whatever they did, purposefully or spontaneously, to ELMM resulted in being in energy deficit - made up for by feeding off energy stores ==> weight (fat) loss. Peter, however has been unapologetic about his insulin-centric bias (on his own blog, I'm not putting words in his mouth). As such, he has expressed a liking or disliking for certain studies, and/or surprise or disappointment for the results of others, based on whether they tend to support or refute his belief system.

So Peter referred to one of my recent posts here, Insulin, Weight & Fat Accumulation, in a post of his own entitled Gourmand Rats. In my post, I expanded on the work of Grey and Knipnis. This study looked at fasting insulin levels compared with body weight in some young obese women under maintenance level and fixed hypocaloric conditions. The results are shown below again.

The fasting insulin levels are all over the map, and yet the subjects either maintained or lost weight predictably. Before we get to Peter's analysis of G&K, I will address his Gourmand Rats post. He begins it with:

You know how it is when CarbSane quotes a paper which refutes the carbohydrate hypothesis of obesity. You really can't be *rsed to chase it but you also know that there will be a fundamentally flawed approach which needs looking at. CarbSane was my route in to Kathleen Axen's work with transfats, which I've probably not finished with yet, but which markedly ramped up my dislike of these industrial lipotoxins. I really enjoyed digging back through the Axen papers, though it took hours, and there's no way I would have hit on them without CarbSane's dire (and incorrect) opinion of LC eating based on the last of the triad. Cracking.

So it is with Grey and Kipnis' paper on the irrelevance of fasting insulin to weight loss. It leads back to a rat paper (aren't you surprised!).

So ... "it leads back to a rat paper" because the authors cited a rat study (that they happened to be the researchers responsible for). How does this in any way mitigate the results of the HUMAN study to which I was referring? In any case, his readers had a bit of a field day at my expense spinning tales of conspiracy theories and whatnot. In the end, the only thing I got out of why Peter cited the whole rat thing was to show some sort of Axen-like bias on the parts of G&K who (paraphrasing) then "designed a study to get the desired result". This was first asserted by commenter Chris. Try as I may in the comments at Peter's, nobody seems to have any idea of how the study was designed to demonstrate that fasting insulin had NO bearing on weight loss in G&K's studies on human women, but it seems to be enough to some for these guys to merely state this in order for many to dismiss the study. *sigh*

Unless there was amputation/liposuction involved (there was not) or insulin levels were artificially manipulated (they were not), simply stating that G&K designed their study to garner a pre-determined desired result doesn't hold water. Put up or shut up on that point, to be blunt.

I think that it might be a good idea to state here that I'm a calories-in calories-out sort of a person. Arguing about metabolic advantage is pointless. When a person loses weight they convert tissue to energy, amputations excepted. Where the calories go, whether it is BMR, thermogenesis, glycosuria, increased spontaneous movement, shivering etc, the calories always go somewhere. As far as I am aware no one is suggesting that calories evaporate. Certainly I'm not.

In between, he highlights the case of one subject who lost weight on maintenance level calories. Despite the fact that her fasting insulin jumped around, Peter's explanation was essentially that she ate less because with low fasting insulin she was less hungry. You can go see for yourself that I asked for clarification of this and received a rather nasty response. Somehow I'm the one incapable of reading and interpreting data for a study where fasting insulin levels and body weights were actually measured and reported. In his article, however, Peter cites another study where insulin levels were not reported, but "if we accept anything from GnK's work, I think we have to accept that under weight stability we can dial fasting insulin by adjusting carbohydrate intake." Huh? How scientific, to assume anything rather than looking at actual data.

So, here I will provide two more weight loss studies, among the hundreds I've read, and maybe thousands that have been conducted where fasting insulin levels HAVE been measured and reported.

First let's look at this study, I've blogged on previously and continues to provide evidence countering LC dogma. In a nutshell, this was NOT a weight loss study. " a weight-maintaining diet (15% protein, 35% fat, and 50% carbohydrate) for 2 wk, an isocaloric diet (30% protein, 20% fat, and 50% carbohydrate) for 2 wk, and an ad libitum diet (30% protein, 20% fat, and 50% carbohydrate) for 12 wk." Despite being given extra foods during the 12 week ad lib phase, the subjects reduced intake by ~440 cal/day on average and lost an average of 4.9 kg weight and 3.7 kg fat mass.

Did insulin levels, fasting or otherwise, have an impact here? Nope. Behold.

(square = maint. phase 1, dot = HP isocaloric, triangles = HP ad lib)

Not only did fasting insulin not differ, but overall insulin seems to differ very little here.

OK, but ... but ... but ... These diets were all 50% carbs ... whattabout low carb? Well, for this one we have a study that was cited by Westman et.al. discussing how low carb diets (really) work. Here, the obese men spontaneously cut around 1000 cal/day when carbs were severely restricted - and didn't replace carbs with increased fat or protein. The predictable result? They lost weight! Everyone please see King's avatar amongst my followers ;-)

(filled = before, open = after/LC)

Fasting insulin darned near identical.

So ... how many more studies should I post to support my contention that fasting insulin changes in an individual has absolutely squat to do with weight loss before someone challenges Peter on his unsubstantiated assertion?

90 comments:

I love that you are someone who eats relatively "low-carb" yet does not buy into the hype of the extremists. You provide some very valid points for consideration, and I agree, insulin restriction is probably not the answer. What is your opinion on the robb wolf/palio doctrine? Basically avoiding inflammatory foods and foods that might cause digestive issues.

I don't buy that insulin level is the primary determinant of weight loss, as you probably know from multiples comments i've made here, but i'm just curious, in the last graph, and the last paper, insulin level don't look very much the same to me, and the authors say that 24h insulin level was statistically lower in the LC diet. Is there anything i'm missing?

@Frank: I do not contest that 24 hr AUC (area under curve = total insulin exposure for those not familiar with the terminology) tends to be lower with low carb. That's sort of a "duh" thing to me. Generally only with extreme iso-protein manipulations between VHF/VHC does one see these differences in 24 hr AUC, but it doesn't even seem to rise to statistical significance in most studies I've seen (especially free-living "real" results).

Not a scientific study but I can tell you that I've measured serial fasting insulins on literally thousands of patients.

I've seen people with fasting insulins exceeding 500 and those with fasting insulins closer to 20.

Every single person I see has weight to lose.

I can also tell you I've seen people with high fasting insulins lose wonderfully on non low carb diets and I've seen people with very low fasting insulins struggle with loss, including on low-carb efforts (we don't espouse any particular diet in our offices).

I wish it were as straightforward as a single variable equation. Would make my life and my patients' lives much easier.

You say:" Voight lost weight eating potatoes by estimating his energy needs and eating a controlled amount of predominantly potato-derived calories. "

But no, he didn't! That is exactly what he did not do.

Voight was interviewed by Stephan on Whole Health Source. (http://wholehealthsource.blogspot.com/2010/12/interview-with-chris-voigt-of-20.html)He said: "During the first three weeks of the diet I only ate until I was full."After that he explains how he had to consciously overeat to not lose as much weight.

Then you say:"My point was that, there was a much simpler explanation for why Voight lost weight: He 'expended more calories than he took in. Why? Well, likely because Voight monitored his intake."

No, he didn't see above EXCEPT when later he did - but in the OPPOSITE way that you think: he had to consciously overeat beyond fullness, and I quote from Stephan's interview again:"After the third week I had lost 12 pounds and realized that I needed to change strategy. I then began to eat more potatoes despite the sense of fullness I was experiencing. So for the remaining 5 ½ weeks I was very diligent about eating the 2,200 calories. I continued to lose weight but at a slower place."

Then you say: "Perhaps he underestimated maintenance levels, blah etc. blah... But my premise is that: The ultimate determinant of weight loss is being in energy deficit. ~Penelope Jones"

Well, yes, but the whole point (now speeding past your head and off into the distance) of Peter's post was to explain the METABOLIC DETAILS of HOW that could work in the body with a high carbohydrate intake. And his point was basically that Voight was still normal and healthy and so, his body could handle it, his liver could handle it. This might not be the case for everyone.

You say:"Try as I may in the comments at Peter's, nobody seems to have any idea of how the study was designed to demonstrate that fasting insulin had NO bearing on weight loss in G&K's studies on human women, "I explained this in my most recent comment over on Hyperlipid, but I'll put it here.The rat study illuminates the human study results because it lets the rat out of the bag by showing that the attempt to make the lowcarb/high fat rats eat the same amount as the highcarb rats FAILED - so they had to do it the other way around: i.e. give the high carb rats only as much as the lowcarb rats were hungry enough to eat.

It also explains how they got the idea for the human experiment. They mention again in the discussion part of the rat paper about how they think the hyperinsulinaemia of obesity is due to all the carbs eaten by the obese rather than a consequence of being obese and then they set out to prove it in the human experiment.

And they do this by locking up teenagers and only allowing them a liquid diet for the best part of 3 months. And they show this because they FIX calories. When the liquid diet is only 1500 kcal the girls lose weight because they are given nothing else to eat at all - they have two options -drink their 1500 calories or drink even less than 1500 calories. I imagine they were pretty hungry on at least one of those diets....

Peter appears to be confusing correlation with causation. Because there is often a correlation between fasting insulin and weight, it leads him to believe that lower fasting insulin is *causing* the weight loss. However, this is the cum hoc, ergo propter hoc (with this, therefore because of this) fallacy. In fact, it is the weight loss that often causes decreased fasting insulin (due to increased insulin sensitivity), not the other way around.

Peter needs to take a look at this paper:

http://www.ncbi.nlm.nih.gov/pubmed/10837283

In this paper, subjects actually increased their carbohydrate intake from baseline, yet lost weight. There was no change in fasting insulin levels. If lower fasting insulin is what causes weight loss, why did these subjects lose weight?

Another thing...if lower fasting insulin determines weight loss, then that would imply that higher fasting insulin determines weight gain. This would mean that elevated fasting insulin levels should predict future weight gain. However, there is a wealth of data that shows this is not true:

@Jay: I do thank you for posting here. I was not aware of Stephan's interview with Voight. So ... the potatoes (glucose and insulin spiking evil carbs) were so filling the man had to force himself to eat more to keep from losing too much weight!!!! Now THAT is, as Kurt loves to say, *interesting* :)

The point of why he lost weight is that he ate less! How, why, schmow, schwhy. Peter knows not Voight's fasting or postprandial insulin or anything. But his weight loss on potatoes only apparently caused a degree of cognitive dissonance so as to cause the cerebral stress (distress) to try to explain it all.

Your insistence that the point of how he lost weight is that he "ate less" continues to boggle the mind.

NO ONE disagrees that he ate less.

The only interesting question to someone who thinks, and is not just playing the nihilist, could posssibly be WHY did he lose the weight while consciously overeating?

I think the best explanation is monotony.

Your explanation was that he counted and measured in order to undereat, which has now been falsified, by exactly 180 degrees.

And this is your response -"How, why, schmow, schwhy"?

Your explanation, as usual wrong, was that he consciously underate.

It is only because you have absolutely nothing novel to say about fat loss that you don't even find it disturbing that you are totally wrong about whether he consciously overate or underate.

You suffer no "cerebral stress" because you are not thinking.

Endlessly repeating that there must be a caloric deficit as if that means something, which no one commenting on your blog has contested, and insisting all the while that it does not matter and you do not care why anything happens.

- this behavior is not stressful, because it is speech that requires....

no thought.

We get that you are really, really angry at Gary Taubes and anything that even looks like it might be one of his ideas.

You're rapidly depriving me of all my 'heroes', regardless of who's 'right'. The insinuations made elsewhere are ridiculous, not to say pathological. An epidemiologist would throw out a press release saying: "Very low carb diets cause paranoia and hostility". We know of course that association is not causation ;-). Please continue your twaddle. I don't buy everything you say (I even hate your gluttony argument regarding the obese), but I want my beliefs to be constantly challenged, thank you.

Hi Yoni! Thanks for that input. It does seem that there is a correlation between fasting insulin and BMI just as one exists between lean body mass and basal metabolic rate. But it's way more complicated than just changing insulin levels. I wish it were that simple!

Sorry Melchior! I'm a bit surprised at Peter and I'll leave it at that.

Kurt, what interests you apparently doesn't interest me. That doesn't mean I'm some addle brained idiot. It doesn't interest me one iota to spend hours pondering why a man could lose weight eating potatoes, why he ate less or why he had to force feed himself to eat more so as not to lose too much. Maybe there's something to all those stupid nutritionists recommending fiber for fullness after all. Wouldn't that be interesting? LOL

Is it really so hard to see that the two premises that you present at the beginning of the post are not exclusive? You can easily combine them:

1) The ultimate determinant of weight loss/gain are the calories we consume and expend. (a trivial fact)2) In an ad libitum diet the ultimate determinant of the calories we consume is fasting insulin due to lipolysis-mediated access to adipose tissue calorie stores. (a hypothesis)

That is the real nature of the argument that Peter is trying to make. I am not saying that the second premise is correct. (From what I've read so far on your blog it isn't per se. So I second Melchior when he says that it is a good thing that you constantly challenge some of the low carb believes.)

Just about every well controlled study I've read produces results that are consistent with H1 being true. The results of G&K and the two studies in this post are all inconsistent with H2. In the case of G&K the researchers did not intend to test H2 but they do so pretty well in the end. You see, they manipulated diet and it did result in changes in fasting insulin levels. In the LC phases levels went down, in HC they went up. But the subjects either lost no weight or lost weight consistently INDEPENDENTLY of fasting insulin levels.

Also Christian, another way to look at G&K from a scientific hypothesis point of view is this. G&K manipulated carb content and caloric content of the diets. In study 1, calories were at maintenance levels and all but 1 were relatively weight stable. In study 2, calories were pegged at 1500 and all lost weight. Fasting insulin changes in response to diet varied significantly low on LC, high on HC, but body weight and changes did not correlate with insulin levels. The isocaloric women maintained, the calorie deficit women lost weight.

Well, the unbiased researcher would first of all phrase the "hypothesis" correctly and then probably come to a different conclusion than you do. :)

Also the unbiased researcher would, when repeating a hypothesis of a fellow researcher, state the hypothesis as clearly as possible and in context. For example your H2 is ridiculously out of context and imprecise. You can do that of course and counter it with the G&K study. Congrats.

If I understood Peter correctly (which might not be the case, because I only read the parts you quoted so far), the most condensed version of his hypothesis is this:

"2) In an ad libitum diet the ultimate determinant of the calories we consume is fasting insulin due to lipolysis-mediated access to adipose tissue calorie stores. (a hypothesis)"

If you phrase it this way, the G&K study provides zero (literally zero) evidence against or in favor of this claim. And again: I am not saying that his claim is correct. (I believe it isn't.)

And as you say H1 is not a hypothesis but a fact. Everyone agrees with it (Peter and Gary Taubes included). If you find a well controlled study that conflicts with H1, the researcher who did the study would qualify for a nobel prize.

@ChristianI believe that CS's version of H2 is more accurate than yours at least for Gary Taubes, otherwise I wouldn't know what to make of this post:http://www.garytaubes.com/2010/12/calories-fat-or-carbohydrates/IMO he is saying that for *fat* loss (not just weight loss) calorie restriction truly doesn't matter, only carbohydrate restriction does. If you only cut calories and keep carbohydrate high, lean tissue will be destroyed to provide energy. In order to free fat from adipocytes, insulin levels must come down.

Your version of H2 makes much more sense, I agree, even though I also think it's incorrect, but I don't think it's what Gary Taubes and probably Peter too mean.

@Christian"IMO in this post he is just saying that if you want to derive meaningful results from a scientific study you have to control variables."Given that the variables are calorie and carbohydrate intake, he clearly believes that carbohydrate intake is important for fat loss regardless of calorie intake.

Gary: "It’s a whopper because it begs this question: is it the total calories consumed that is the variable determining weight loss? [...] Because it’s quite possible that the only meaningful way to lose fat is to change the regulation of the fat tissue, and the science of fat metabolism strongly implies that the best way to do that, if not the only meaningful way, is by reducing the amount of carbohydrates consumed and/or improving the quality of those carbs we do consume."

It is clear to me that he believes the ultimate determinant of fat loss (though probably not of weight loss) is insulin levels (fasting or postprandial), not calories, in an ad libitum OR calorie-restricted diet. To lose fat you have to cut carbs; if you don't cut carbs, only calories, you lose lean tissue. And I also could be mistaken about what Peter believes, but if he agrees with Taubes, I think CS's version is more accurate than yours.

Welcome to the Asylum Wild at Heart! I'll put it on my list to exhume a post on Paleo and publish it for you, Aaron and anyone else who's interested in my thoughts.

I would say that I happened across Rob's blog when he returned from a hectic book tour, much like GT, he was reporting being a bit under the weather and not in the best of shape. Granted such stressors impact us all, and perhaps he better fared the stressors on Paleo than SAD, but it is an interesting anecdotal reality.

Taubes point is about controlling variables, but he picked a piss-poor study to discuss this in the context of. Not because of anything Shai did wrong, but because it was a lengthy (2 year) free-living study. My only criticism might have been that perhaps we could have bothered the participants - all of them - just a little more frequently to keep slightly longer (in terms of days) self-report data. It's still not optimal, but it would be preferable.

Christian, clearly trying to word things in your manner is just making matters worse. You seem incapable of understanding how scientific studies are designed and controlled.

Gary is clearly saying in that blog post (and apparently in WWGF though I'll not waste money on it) that people lose weight on diets because they reduce carbs (and by inference insulin) and release fat - the calories don't matter.

G&K is actually a perfect study to test GT's hypothesis - THANKS for another blog post idea! They controlled calories while manipulating calories in iso and hypocaloric contexts. Weight loss occurred when calories were reduced, but not when carbs were. Fancy that!

re. "IMO he is saying that for *fat* loss (not just weight loss) calorie restriction truly doesn't matter, only carbohydrate restriction does. If you only cut calories and keep carbohydrate high, lean tissue will be destroyed to provide energy. In order to free fat from adipocytes, insulin levels must come down."

I completely agree. Everyone in these comments (and comments for previous posts) claiming that CICO is a moot point is wrong. Taubes DOES try to get the impression across that calories don't matter and I have heard countless people say that and I have read that countless times by people who follow him. I DO think it's important to keep that fact in mind. To not do so leads people down many stray lines of thinking.

I, for one, support Sane's continuing to mention that inconvenient truth.

@Carbsane - my point is that when Taubes (and others) say that you can loose weight by basically eating as much protein and fat as you want as long as you don't eat carbs, he's conviently overlooking the fact that protein is as insulinemic as carbs. But I guess trying to point this out to a dedicated LC-er is meaningless.I know about Atkin's Fat Fast. That's the real way to go for anyone who actually buys into the insulin fairy tale.

me: >on that page is a table full of examples of tautologies. Please study the table>Which one applies here? >>Tautologies have to do with the definitions of words - liguistics. Scientifically established truth or falsity has nothing to do with tautologouslness. >Conservation laws were not defined into existence: they were empirical science. these laws are true and became applicable from observation, not from definition, not from logic.

___________________http://www.wordnik.com/words/Tautology click# Logic An empty or vacuous statement composed of simpler statements in a fashion that makes it logically true whether the simpler statements are factually true or false; for example, the statement Either it will rain tomorrow or it will not rain tomorrow.

logical tautology: if your summed inputs are greater than your summed outputs you will gain weight gain or lose weight.not: if your summed inputs are greater than your summed outputs you will gain weight.

_______________http://www.thefreedictionary.com/tautology click1. (Linguistics / Grammar) the use of words that merely repeat elements of the meaning already conveyed, as in the sentence Will these supplies be adequate enough? in place of Will these supplies be adequate?

NOT tautologous: total inputs lower than total outputs results in less weight.

2. (Philosophy / Logic) Logic a statement that is always true, esp a truth-functional expression that takes the value true for all combinations of values of its components, as in either the sun is out or the sun is not out Compare inconsistency [3] contingency [5]

# Tautology (rhetoric), using different words to say the same thing even if the repetition does not provide clarity. Tautology also means a series of self-reinforcing statements that cannot be disproved because the statements depend on the assumption that they are already correct.

# Tautology (logic), a technical notion in formal logic, universal unconditioned truth, always valid.> it says "unconditional truth", not "always has been observed to be true"

1.needless repetition of an idea, especially in words other than those of the immediate context, without imparting additional force or clearness, as in “widow woman.”

> Please oh please tell me how ELMM is the same as widow woman

2.an instance of such repetition.3.Logic.a. a compound propositional form all of whose instances are true, as “A or not A.”b. an instance of such a form, as “This candidate will win or will not win.”

World English Dictionarytautology (tɔːˈtɒlədʒɪ) [Click for IPA pronunciation guide]

—n , pl -gies1. the use of words that merely repeat elements of the meaning already conveyed, as in the sentence Will these supplies be adequate enough? in place of Will these supplies be adequate?2. logic inconsistency Compare contingency a statement that is always true, esp a truth-functional expression that takes the value true for all combinations of values of its components, as in either the sun is out or the sun is not out

_________________________________http://fs.gallup.unm.edu//tautolog.txt click> I doubt the ones who need it will work through the examples to find one that applies

_______________________http://en.wikipedia.org/wiki/Tautology_%28rhetoric%29 click> after you've gone through that table, go down a bit further:

my prediction: some will1 try to "answer" by insulting me 2 pop up straw men 3 dwell on meaningless outside trivia 3 justify their usage as "normal and correct english" 4 retreat to some position that's equivalent to this and will never admit it

If you can't even get a simple word right; what hope in hell do you have of understanding the nature of explanation and non-explanation?

Thanks for these Sanjeev. I am getting sick of such terms as tautology (used correctly or not) as well as (sorry JamesK, I'll exempt you 8)) all latin phrases so ter go mie to vod ca im bib. Or, Gunter glieben glauchen globen

Don't sweat the typos. I need to proof-read several hours after composing a post in order to catch my own, else I read what I initially intended and tense/singular-plural mismatches don't get picked up. I figure it's better to expend time and energy on more meaningful things unless an error changes meaning too dramatically :-)

"I completely agree. Everyone in these comments (and comments for previous posts) claiming that CICO is a moot point is wrong. Taubes DOES try to get the impression across that calories don't matter and I have heard countless people say that and I have read that countless times by people who follow him. I DO think it's important to keep that fact in mind. To not do so leads people down many stray lines of thinking."

x2 here. I wish kurt would understand that it might not be the causative factor per se, but, first, it is utimatly what will determine weight loss or not and second, many people on LC believe that calories are not important, so yes, it bears repeating it over and over.

Sanjeev maybe you should try to read more carefully and understand what Kurt, I and others are actually saying. (I hope this fulfills your prediction #1).

The conservation law itself and in particular the sentence "if your summed inputs are greater than your summed outputs you will gain weight" is of course not a tautology. NOBODY IS CLAIMING THAT. Maybe you should try and understand first what others are saying prior to doing all this nonseless quoting of tautology definitions.

Here, just for you, for the thousands time: If you are in negative (positive) caloric balance you are losing (gaining) weight. That is -> a fact-> follows from a physical equation-> is not controversial-> is not a tautolgy

Now if you then ask the question "what causes obesity / weight gain" and then your explanation is that "weight gain is caused by positive caloric balance" then this is-> nonsense-> dull-> gaga-> a tautological explanation

You can even find the justification for this in the things you quoted because if you have established the empirical fact that you are gaining weight by being in positive caloric balance (which nobody questions), then you ask "-> why <- are people gaining weight?" and then you answer "because of positive caloric balance" you are

- "merely repeating elements of the meaning already conveyed" and- "using different words to say the same thing even if the repetition does not provide clarity".

Thanks for finding those by the way.

So where does that leave us?

-> Can you lose weight by ELMM? Yes of course.-> Can you do it by conscious counting of intake and estimating of expenditure? Yes.-> Is this the only working strategy? No.-> Do calories matter? Yes. -> Is CICO reality? Yes. -> Does it explain obesity? No. -> Can it give us any hints for optimal, sustainable and effortless weight loss? No.-> Is there even such a thing? Who knows.

I was reading this paper and the following quote just blew me away. http://www.ncbi.nlm.nih.gov/pubmed/10078559

"FFAs not only inhibit insulin action, however; they also stimulate insulin secretion. While it has been known for some time that FFAs can acutely stimulate insulin secretion (7–11), it has only recently been recognized that FFAs have also prolonged stimulatory action on insulin secretion."

Whoa! FFAs stimulate insulin?! I guess this is news to me. More fodder for the insulin hypothesis, although is appears most readers here have long ago stopped believing in it.

Robert wrote: Taubes DOES try to get the impression across that calories don't matter _________________Taubes goes a lot further than that. He comes as close as you can to writing "insulin creates mass out of vacuum" without writing those words.

old post: Gary Taubes: ... they eat no more than the lean—surprising as it seems, the evidence backs this up ...

GCBC chapter 14 paragraph 3

The more closely we look at the evidence and at obesity itself, the more problematic the science becomes. Lean people will often insist that the secret to their success is eating in moderation, but many fat people insist that they eat no more than the lean—surprising as it seems, the evidence backs this up—and yet are fat nonetheless. As the National Academy of Sciences report Diet and Health phrased it, “Most studies comparing normal and overweight people suggest that those who are overweight eat fewer calories than those of normal weight.” Researchers and public-health officials nonetheless insist that obesity is caused by overeating, without attempting to explain how these two notions can be reconciled. This situation is not improved by the prevailing attitude of many nutritionists, obesity researchers, and public-health authorities that it is evidence of untoward skepticism to raise such issues, or to ask questions that lead others into contemplating the contradictions themselves. _______________James Krieger commented on it: Sanjeev, When Taubes quoted that piece from the NAS report, he left out some important adjacent sentences about underreporting (underreporting was suspected back in 1980 until it was confirmed using doubly labeled water in the 1990's). This is consistent with CarbSane's observations of how Taubes consistently cherry picks from his own references. February 10, 2011 7:40 PM

addendum: hey Robert - just to be clear, if Taubes were to support (pay lip service to) some of my own personal BS ideas I would look through all of Taubes' work and find something to agree with and praise hum for it, and not hold his feet to the fire.

hehehe ... yeah, I TOTALLY would. Have your people call my people, Taubes-dude. We'll do lunch. Or inject insulin to create the needed mass in a weird pattern on our arms.

"> Can you lose weight by ELMM? Yes of course."Agreed."-> Can you do it by conscious counting of intake and estimating of expenditure? Yes."Agreed."-> Is this the only working strategy? No."Agreed. Although, of course, any unconscious and non-counting strategy will only work insofar as it achieves the same result as a conscious counting strategy...that is, negative energy balance. As such, consciously ensuring an energy deficit will necessarily work; other strategies may or may not...hence the continuing emphasis on energy balance 'mindfulness'."-> Do calories matter? Yes."Agreed. "-> Is CICO reality? Yes."Agreed. "-> Does it explain obesity? No."Yes and No. It actually does explain obesity at the physical level - that is, people eat more now than they did before. Had they not done so, we would not have seen the rise in obesity, even allowing fro fructose, wheat gluten and the other usual suspects.But, yes, at the sociological level, CICO is not a satisfactory explanation of why we, as a society, eat more per person than we did 30 years ago."-> Can it give us any hints for optimal, sustainable and effortless weight loss? No."I think the success stories at the NWCR refute this somewhat...ELMM seems to be the ticket for the vast majority of registrants, and that flows directly from CICO."-> Is there even such a thing? Who knows."Optimal, yes. Every one has a WOE that is axiomatically 'the best for them'. As for effortless, probably not...I doubt we would have evolved in a way that rewarded abstinence in the face of calorie availability....it will always require 'effort' to volitionally abstain from pleasurable sensations.

Actually I am not claiming that for "ELMM" because it is too losely defined for my taste.

"Although, of course, any unconscious and non-counting strategy will only work insofar as it achieves the same result as a conscious counting strategy...that is, negative energy balance."

Agreed.

"It actually does explain obesity at the physical level - that is, people eat more now than they did before."

Agreed.

Still this is no satisfying "explanation" - this also just rephrases the problem (or question). And more importantly this rephrasing then partly implies that the problem or explanation is entirely social or psychological (willpower etc.). This is not necessarily true. (I am not saying it is not because I can't prove it). I am still open to the idea that regulatory hormones (insulin, leptin, ...) and their associated resistances or deseases are contributors in this matter as a causal factor.

Your Kurt:> Your explanation was that he counted and measured in order to> undereat, which has now been falsified, by exactly 180 degrees.

what she actually wrote: > Well, likely because Voight monitored his intake

"likely because" ... Where's the 180 degrees? More like less than 0.28 rads or greater than 6 rads. It's 180 degrees for Taubes, maybe for Peter, not for CarbSane (or for example for James Krieger who wrote about Insulin's satiating properties long ago).

Even Jay, the poster who pointed that out, didn't need to magnify it like that. Why do you?

And apparently when that poster realized the new understanding he provided is worse for Peter than CS's original wording he had no reason to escalate the issue. Apparently you don't have as much sense.

Since when has the lynchpin of CS's argument been "Voigt counted calories?"

Interesting that you COMPLETELY MISSED and AVOIDED the main thrust of the post and fixated like a rabid wolverine on miniscule trivia.

Einstein used conservation laws to derive some behaviours of light in gravity and when fired from a moving emitter.

That was a much simpler problem than obesity. But to solve our more complex problems, our latter day SOOOOOOPER GEEEEENIUSES don't need the tools of exploration, inquiry and sense making that simpletons like Einstein needed to solve much simpler problems.

The simplest engineering projects anywhere in the world are shot through and through from day one with applications and restatements of conservation laws. But to understand far more complex biological systems, these beings from a higher plane don't need the tools that millions of PhD engineers use day in and day out their whole lives (to understand (!!!)SIMPLER(!!!) systems)

I see that CS is a sea of calm compared to her self-appointed chief "nutswinger", you. Why is she so reasonable compared to you hanger's-on? You're gong to give yourself a stroke.

I was addressing her, you know. Unless you are her, which I suppose is possible, but seems unlikely.

Did I address you or call you names? No. I did not.

But I am a "rabid badger tautology boy". I kind of like that. : )

I must have struck a nerve. I suppose you are starting to realize that logically, answering the question of how people lose weight by saying that they have a caloric deficit is indeed tautological, in the same way explaining that the reason someone won the race is because they ran faster.

It makes one sound foolish to say either one, over and over again, unless trying to make it a song or a mantra or something.

My 8 year old nephew understands that perfectly. But he's not as angry as you are, so he can think straight. But he resorts to name calling, too, when he knows he's wrong and just can't stand the fact...

CS at least has some interesting things to say, even if I disagree with some of them.

From you, I am still waiting for something other than anger and insults

Now you may carry on now with more quickly banged out, error ridden angry posts...

********It makes one sound foolish to say either one, over and over again, unless trying to make it a song or a mantra or something.**************

Actually, it's not foolish at all. The reason is that it allows for examination of where the problem may lie.

If I am not losing weight, then I know that either I am consuming too many calories, not expending enough, or both. This allows me to narrow my focus as to where the problem may lie, and is my first step towards correcting it. It is absurd to suggest that this is somehow redundant or useless information, simply given the fact that there are numerous people out there (especially low carbers who somehow believe that the concept of energy balance doesn't apply) who scratch their heads as to why they're not losing weight. They'll point fingers at everything OTHER than energy balance...it's too many carbs, too much insulin,too much omega 6, too much this, too much that, etc, etc, etc. And all the while, ignoring what you claim to be "tautological"...the fact that they are not expending more than they are taking in.

It is this whole "tautological" nonsense that leads people to lower their carbohydrate intake to 0, thinking that it will automatically lead to weight loss.

The concept of energy balance is not tautological because it allows us to focus as to where the problem may be, and ignore non-relevant issues.

Brad Pilon illustrates the issue best here:

http://bradpilon.com/weight-loss/fruit-makes-you-fat/

People make all sorts of claims about what makes them fat, yet no one ever says "I eat too much".

James wrote: "It is absurd to suggest that this is somehow redundant or useless information [...] And all the while, ignoring what you claim to be "tautological""

Could you please make an effort and try to understand what it is exactly that is tautological and what not? The concept of energy balance is tautological? Here is what I wrote:

"Here, just for you, for the thousands time: If you are in negative (positive) caloric balance you are losing (gaining) weight. That is-> a fact-> follows from a physical equation-> is not controversial-> is not a tautolgy"

Surely many people are ignorant of what it takes to lose weight and they need to be reminded that calories in must be less than calories out. So in the context of a weight loss support forum for laypeople this constant reminder might be appropriate, just as it would be necessary to explain to a baseball neophyte that the team with the most runs will win. But in the context of a forum with highly educated experts who already all agree on CICO, it is problematic to use CICO as a way to discourage some of those scientists from taking a deeper look at the cause of the problem. That would be analogous to telling a sophisticated baseball analyst that his explanations for won loss records are bunk because they fail to appreciate the simple answer - that the team with the most runs wins.

******But in the context of a forum with highly educated experts who already all agree on CICO, it is problematic to use CICO as a way to discourage some of those scientists from taking a deeper look at the cause of the problem.***********

I would contend that this is a strawman. First, no one is trying to discourage anyone from taking a deeper look. There is a huge body of fascinating research out there that has looked at an enormous variety of reasons as to why we are in a positive energy balance.

This also leads to my next issue with your statement. You say "THE cause", implying it is singular. Why do you imply that the cause of positive energy balance is a singular cause?

Third, the concept of positive energy balance is even useful to the expert. For example, I had a client who came to me who could not figure out why he wasn't losing weight. He was using an intermittent fasting approach, eating mostly whole, unprocessed foods, and exercising regularly. He kept meticulous records of both his food and activity. It seemed that he was doing everything right. Yet he was struggling.

I used the concept of energy balance to narrow down where the problem might be. I knew that either he was eating more than he thought he was eating, he was expending less than he thought, or both. Then it became an issue of finding out exactly where. There were 2 things that stood out to me. First, the client ate a lot of cheese. Cheese is notoriously energy dense, and any slight mismeasurement of your cheese intake could lead you to easily overconsume calories. Second, the client said he had a desk job for 10 hours a day. This told me that, despite his exercise, his NEAT was likely extremely low and canceling out any energy-expenditure benefit of exercise.

Thus, the simple concept of energy balance allowed the "sophisticated analyst" such as myself to determine the causes of this client's problems.

did the fact that the conservation laws already exist stop Einstein from deducing light's blue and red shifts in response to gravity or being emitted from a moving emitter, or sensed at a moving detector?

NoCompletely the opposite.

In fact he USED conservation laws to get there, and it's usually taught that way all over the world today.

He made NEW DISCOVERIES USING the conservation laws.

Quite an accomplishment for a tautology, don't you think?

Do the conservation laws stop engineers from looking for better designs - for electronics, for motors - almost anything Engineers analyze and design?

Model a system using conservation laws and you can apply all kinds of mathematical tools and techniques to it. You can ask all kinds of new questions that you can't with the actual system, and if you've applied the laws correctly you can get surprising results.

Why on earth would you willingly surrender all that? To pursue magic, pixie fairy dust theories?

Conservation laws PROVIDE avenues for exploration. They suggest ways to look for answers and the places to look for them.

Far from stopping anything they've been used through out the history of science as SOURCES for new science.

Todd Hargrove said... James, his explanations for won loss records are bunk because they fail to appreciate the simple answer - that the team with the most runs wins._______________that's true BY DEFINITION. That's what a tautology is, DEFINITIONAL.

Please look at all the examples on the pages I linked to. There's dozens of examples there to clarify what the description says.

CICO is true because of past scientific observation and repeated experimentation not because it's defined true.

Scientific explanation simply cannot be a tautology - the wiki page I linked to is very specific about it, even past all the examples: physics equations cannot be a tautology.

I would also note that your baseball analogy is flawed. Even baseball neophytes understand that "who scores most wins". However, obviously the vast majority of people wanting to lose weight don't understand CICO, or have been misled by individuals like Taubes.

Great post on conservation laws and how they lead us down the path of more exploration. This explains how I used conservation laws to solve the reason why my client was struggling. I used the laws to explore deeper, rather than tossing them aside as some sort of "tautology".

I freely grant that CICO is true and I concede that some people think that they can eat any amount of total calories and lose fat by magic. I don't personally know anyone like that, but you may.

Some people who eat ad lib LC lose substantial fat with no counting or measuring. I have seen and treated many such people with better success than with any other approach. None of them think it is magic. They all notice spontaneously lower hunger.

Some people have even better results specifically restricting excess fructose and PUFA - including reversing fatty liver and diabetes and many other non-weight related metabolic derangements. They don't need to count or weigh or measure either. Many such people go back to higher carbs as starch and do not re-gain the weight.

Some people have no luck with either of these maneuvers. They may need to give it more time, or try something else, perhaps even weighing or measuring! Or having their thyroid function checked, or seeing a clinical psychologist or psychiatrist about why they are self-medicating with a gallon of Bryer's every evening.

But to say over and over again that CI=CO is to terminate the conversation a bit early, isn't it?

How can we explain WHY these methods work when they do (and they do, even if not for everyone) if we keep perseverating on a fact that we all agree on?

A fact that is true, but by itself explains nothing, and is therapeutically useful only in the specific case of someone who thinks they can overeat and lose weight, but is not?

Why initially treat with the expensive drug before we know if the cheap and easy one works?

Dietary maneuvers are all likely to be variants of ways to induce a caloric deficit.

One can lesion the brain, do a vertical banded gastroplasty, remove the pancreas surgically - all of these will make you lose weight.

More reasonably, one can decrease carbs or increase protein.

More reasonably yet, one can restrict excess fructose and wheat specifically.

FInally, if nothing else works, you can count and measure and weigh to ensure a deficit, and if you can tolerate the hunger, that might finally work for you.

But why is that last, desperate step the only thing worth discussing?

Do you view the human organism as simply a neutral caloric sink without complex hormonal appetite regulation and no organ sensitivity to toxins?

We are stipulating that there must be a caloric deficit, somehow. In a murder trial, one might stipulate that the victim is dead, but then argue it was self defense, or someone else besides the defendant who did it, etc.

Continually invoking an inarguable, stipulated condition this way is like the prosecutor blurting out "but the victim is dead" every five minutes or so during the trial.

The judge might well interrupt and say "Yes, that's been stipulated by the defense, and they are denying that the defendant killed them! Move on, counselor".

Make your case. That is, tell us why some people don't need to count or weigh and they can lose weight. We've stipulated a caloric deficit. Now let's move on to how that happens.

"However, obviously the vast majority of people wanting to lose weight don't understand CICO, or have been misled by individuals like Taubes."

Is that your experience? I find that hard to believe. I've met some people who lost weight successfully with Atkins who believe that, but the vast majority of people? I doubt it.

Where I live everyone believes the precise opposite, that math is the only way to lose weight, and a calorie is a calorie. They all eat dry salads and low fat garbage and spend hours on stairmasters and treadmills at the Y.

They are all fat because the only thing they have ever been taught is that calories count - so they count them and starve, or stay fat.

> But why is that last, desperate step the only thing worth discussing?

I've not read anyone write that on this blog.

I've written about people successfully losing long term on Pritikin and Ornish and Atkins and so on and so on. Have I (or almost anyone here) ever written that any of those strategies are useless and discussion should end because CI=CO?

But you tell people to abandon CI=CO and they come back 6 months later, heavier, what are you going to do. If you "moved on" from it, that is.

********I freely grant that CICO is true and I concede that some people think that they can eat any amount of total calories and lose fat by magic. I don't personally know anyone like that, but you may.************

Then I suggest you make your way to the dozens of low-carb forums out there, and you will find numerous people who think CICO is nonsense.

Even people like Fred Hahn, who (whether he deserves to or not) have numerous followers, have tried to argue that it's about carbohydrates and insulin, not calories.

I've had people come onto my website and try to tell me that CICO is nonsense.

Even Taubes himself has convoluted the CICO issue, which CarbSane has pointed out on this blog. So it's no wonder why so many in LC circles believe what they do.

**********FInally, if nothing else works, you can count and measure and weigh to ensure a deficit, and if you can tolerate the hunger, that might finally work for you.**************

You are creating a strawman here, by essentially convoluting the concept of CICO with weighing/measuring food and "tolerating hunger".

*********But why is that last, desperate step the only thing worth discussing?***********

I don't know why you keep insisting on this strawman. I don't know of anyone here claiming that it's the only step worth discussing.

***********Where I live everyone believes the precise opposite, that math is the only way to lose weight, and a calorie is a calorie. They all eat dry salads and low fat garbage and spend hours on stairmasters and treadmills at the Y. ************

Again, Kurt, your comments are full of strawmen. First, CICO doesn't mean "a calorie is a calorie". CICO doesn't mean "math is the only way to lose weight." You are mixing in the concept of CICO with these things as if they are equivalent, when they are not.

*********They are all fat because the only thing they have ever been taught is that calories count - so they count them and starve, or stay fat.************

Again, CICO and "calorie counting" are separate issues.

Another issue is your reliance on anecdotes. When you look at the research, did you know that only 20% of people have actually tried ELMM to lose weight?

http://anthonycolpo.com/?p=1302

*********We are stipulating that there must be a caloric deficit, somehow. In a murder trial, one might stipulate that the victim is dead, but then argue it was self defense, or someone else besides the defendant who did it, etc.

Continually invoking an inarguable, stipulated condition this way is like the prosecutor blurting out "but the victim is dead" every five minutes or so during the trial.**********

This is a terrible analogy. No one argues that the victim is dead.

However, people argue against CICO all the time. ALL OF THE TIME. You claim that you haven't experienced it, but it makes me think you've been pretty sheltered then.

Brad Pilon made an excellent post here:

http://bradpilon.com/weight-loss/fruit-makes-you-fat/

So many people blame anything OTHER than how much food they eat as to why they have gained weight. The fact is, until people accept this reality, they aren't going to get anywhere.

Yes, you can argue WHY we eat too much until you're blue in the face, but until people accept that they actually eat too much (which many people don't...and the research shows this, despite your anecdotes), you aren't going to get anywhere.

How do you think Taubes or Fred Hahan would've handled my client who came to me and was struggling? They would've used their insulinocentric, carb-focused apporoach and would've told him to eat even less carbs (even though his carb intake was already low).

But that wouldn't have worked, because that's not where the problem was.

Why do so many people bring up Einstein in internet arguments? I heard two yesterday.

I never advocated throwing away CICO, just looking a few steps deeper. Carbsane is the one who's said she is not interested in asking the "why" questions, such as why CICO becomes disregulated in certain individuals. So in your example, Kurt and Peter are the Einsteins, and Carbsane is discouraging their inquiries by calling them "whyners".

Believe us when we say several people don't believe CICO. I agree with you that they are not the majority, but they are a very vocal minority and a lot of them are zero carbers, and if you hung about on lowcarb forums, they would get on your nerves so much you would feel compelled to write a treatise on why CICO is true too.

You also should remember that most people who come here are low-carbers or doing paleo (like CarbSane herself or me), so we fully understand not wanting to count calories and losing weight spontaneously by avoiding junk food.

> in your example, Kurt and Peter are the Einsteins, and Carbsane is> discouraging their inquiries by calling them "whyners"

I'm trying to understand you, so here are some scenarios for clarification: If someone in the next house does something good or bad or indifferent, (let's say bad for the sake of argument), then it makes sense for me to abandon tools that have been found useful in the past, and to tell others to abandon those tools?

simpler: someone takes away my ball peen hammer, would it be best for me to throw away my claw hammer or my mallet or safety glasses or saw or drill or safety boots?

or: I'm debating someone and they make fun of number theory. In fact, they insult and campaign against number theory. Because of that, should I stop using Calculus?

> Continually invoking an inarguable, stipulated condition this way is like the prosecutor blurting out "but the victim is dead" every five minutes or so during the trial.

> The judge might well interrupt and say "Yes, that's been stipulated by the defense, and they are denying that the defendant killed them! Move on, counselor"

GROSSLY misleading

You're NOT stipulating one single isolated fact in court.

It's a demand to 1. suspend a huge fraction of the rules for evaluating evidence 2. close off lines of inquiry that can disprove or dispute facts presented to the court3. close off lines of inquiry that can disprove or dispute theories presented to the court4. close off lines of inquiry that can produce new facts for the court5. close off lines of inquiry that can produce new theories for the court6. Shift burdens of proof away from historically accepted precedence and best practices in science and court

Here's a rough equivalent: The plaintiff stipulates evolution to the court. Plaintiff moves the court to prevent defendant from mentioning evolution in any way shape or form again

*Then I suggest you make your way to the dozens of low-carb forums out there, and you will find numerous people who think CICO is nonsense.*

why do that when I can hang around a place where people think that endlessly pointing out that weight loss means a caloric deficit is the only thing there is to say on the subject?

*You are creating a strawman here, by essentially convoluting the concept of CICO with weighing/measuring food and "tolerating hunger".*

What does one do with the "insight" provided by the CICO paradigm other than eat fewer calories, which requires weighing and measuring food..

Or are you suggesting that something other than calories count - like maybe what kinds of foods we eat?

*I don't know why you keep insisting on this strawman. I don't know of anyone here claiming that it's the only step worth discussing.*

Have you read none of CS's responses? The posts where she says she does not care how it happens - the only thing that matters is caloric deficit?

*Again, Kurt, your comments are full of strawmen. First, CICO doesn't mean "a calorie is a calorie". CICO doesn't mean "math is the only way to lose weight." You are mixing in the concept of CICO with these things as if they are equivalent, when they are not.*

Oh, then please enlighten me, James. When I hear people talk about nothing but an equivalence like CICO, I assume that they have some idea of what to do with it. If you don't count what you are eating and use calculators and such, then I really don't understand the utility of your profound observation that calories consumed and not stored as fat go some where.

Is it just fun to say it a lot?

*Again, CICO and "calorie counting" are separate issues.*

If we both agree that CI=CO, then what is the point of mentioning it ad nauseum. Tell me how you exploit this equation, which you consider to be dense with explanatory power.

*Another issue is your reliance on anecdotes.*

You mean the single patient who was fat due to cheese was actually a randomized trial? Yes, I should really firm up my claims.

I missed the post on this blog where someone claimed CICO Is not true. Maybe you can link it for me. Otherwise the analogy is perfect.

Stipulated means everyone here, including myself, Christian, Peter and Stephan and you and CS and Sanjeev, and everyone I have seen agrees that CICO is true.

What we are arguing about is whether it has explanatory power.

I grant that on some LC discussion forum it might be worthwhile to point out to folks failing to lose on LC that they might try other maneuvers, but I fail to see why those of us who talk about anything else must only speak of CICO or be told that "it doesn't matter how the weight was lost". That is what CS said. If you don't agree with her, why talk to me about it?

*However, people argue against CICO all the time. ALL OF THE TIME. You claim that you haven't experienced it, but it makes me think you've been pretty sheltered then.*

Then why not go to the LC blogs where all these dumb people are arguing this and tell them? I did not say I've not experienced it, I said it was far less common than thinking calories is the only thing to pay attention to.

I told you I've treated many patients successfully with my methods and the ones who think treadmills and calculators are the only way to lose weight outnumber the ones who think you can eat unlimited calories and not gain weight by a large margin.

Both beliefs are wrong, but I've seen way more people who are completely gonorant of the caloric content of their food lose weight and keep it off with my LC approach than I've seen people who only count and weigh (weight watchers etc.) Most of my successes have tried your way first and failed.

For people that can lose weight with LC ad lib, CICO is totally useless information, no more useful than telling someone with asthma or COPD that they need to breathe as much oxygen as they consume, when all they need is an inhaler.

According to your comment below, no one could have lost weight with the first version of Atkins because they would have believed the metabolic advantage and that would have prevented them from success because they were not "accepting reality" about CICO.

*So many people blame anything OTHER than how much food they eat as to why they have gained weight. The fact is, until people accept this reality, they aren't going to get anywhere.*

Not true, as you know already. It is possible to change the type of food you eat with no counting and have no knowledge of the calories consumed and still lose weight. This does not argue either for or against CICO, or even whether LEMM might work as a strategy as well.

*Yes, you can argue WHY we eat too much until you're blue in the face, but until people accept that they actually eat too much (which many people don't...and the research shows this, despite your anecdotes), you aren't going to get anywhere.*

Again, you are asserting something that is totally wrong. It is possible to have no idea whatsoever what your caloric intake is, and lose fat mass. I can't believe you really believe this.

It's as if you know people who died of infection despite antibiotic treatment, and thereby assert that antibiotics must not work.

Perhaps you are confusing the fact that CICO is always true with the idea that if one is ignorant of CICO or of their caloric intake they cannot lose weight. A total non-sequiter.

I know people who've used atkins and loss 50 lbs or more permanently, and some of them believed they were eating less. These people clearly were unaware that they were eating too much, yet they ate less anyway, even without the knowledge you claim to be essential.

@Krieger - continued

*How do you think Taubes or Fred Hahan would've handled my client who came to me and was struggling? *

You'd have to ask them - I have no idea. I've never read anything by Hahn.

Can you please parse these words for me, and identify the extent to which they capture your disagreement with CS?

CS and Kurt: We agree that people lose weight as a function of their negative energy balance.

CS and Kurt: We agree that volitionally or accidentally eating less and/or moving more than one currently does is a necessary and sufficient condition to achieve a negative energy balance.

CS and Kurt: We agree that there are many different means that individuals may employ to achieve less consumption, some involving deliberate measurement of food intake, some involving spontaneous reductions in consumption due to diet manipulation.

CS: In terms of weight loss, I don't care which means people use, so long as they achieve an energy deficit.

Kurt: CS's lack of interest in the means people employ to achieve a negative energy balance, and thus weight loss, is wrong. People should achieve a negative energy balance by avoiding NAD and the spontaneous reduction in consumption that follows.

*******why do that when I can hang around a place where people think that endlessly pointing out that weight loss means a caloric deficit is the only thing there is to say on the subject?*************

No one is saying that it's the "only thing to say on the subject". YOU are the one making that assertion.

Kurt, do you understand what a strawman is?

http://weightology.net/weightologyweekly/?page_id=485

********What does one do with the "insight" provided by the CICO paradigm other than eat fewer calories, which requires weighing and measuring food..***********

The CICO paradigm doesn't require weighing and measuring food. You actually contradict your own statements here, because earlier you mentioned how people spontaneously eat less when they consume more protein. That still falls in the realm of CICO.

***********Have you read none of CS's responses? The posts where she says she does not care how it happens - the only thing that matters is caloric deficit? ************

I won't speak for CarbSane here, but you are distorting what she is saying (at least my understanding of what she's saying). When she says she "doesn't care", she's referring to the fact that there are many ways to achieve an energy deficit, and the best approach for someone is an approach that they can sustain for an extended period of time. She doesn't care whether it's low carb or low fat or a lot of exercise...as long as it's something that works for you.

*************then I really don't understand the utility of your profound observation that calories consumed and not stored as fat go some where. **************

Well if your viewpoint is so narrow that you cannot see the benefit beyond "weighing and measuring food", then there really isn't any use discussing this with you.

************Tell me how you exploit this equation, which you consider to be dense with explanatory power.*************

I already gave an example in another comment of how I used the concept to help a client of mine.

Oh, and I was the research director for the most successful corporate weight management program in the country, with an average weight loss of 40 pounds in 3 months:

http://www.2020lifestyles.com/

Our clients tracked their food intake and counted calories. Wow, what a horrible thing to do. I guess that meant they were "starving" (when they weren't).

***************You mean the single patient who was fat due to cheese was actually a randomized trial? Yes, I should really firm up my claims.****************

Sorry, but you are comparing apples and oranges.

You asked how the concept of CICO could be useful to someone. I gave an example.

That is not the same as you using this anecdote:

"They are all fat because the only thing they have ever been taught is that calories count - so they count them and starve, or stay fat."

Sorry, but the RESEARCH shows that people who count calories have better long term success rates than people who don't. There are numerous studies on this.

Not only that, but you've again convoluted the issue with your "count them and starve" comment. Counting calories doesn't mean starving. Counting calories is nothing more than an awareness tool, no more an awareness tool than weighing yourself on a regular basis or tracking your weights in the gym or regulary checking your blood pressure. It's a tool and nothing more. It helps some people, it doesn't help others, but the research shows it helps more people than it doesn't help.

I have to ask you...if counting calories means starving, does that mean if I count calories on a low carb, high protein diet, that I will starve?

"I have to ask you...if counting calories means starving, does that mean if I count calories on a low carb, high protein diet, that I will starve?"

Nice point, James.

Another suggested question along those lines: "if I count my calories so as to ensure a 2000 cal/day surplus (say I want to bulk up for a sumo competition), will I be starving"?

Kurt really seems to be struggling with the concept of tautology. And that's the charitable assumption...the other is that he knows full well that he's conflating these categories and is wilfully doing so for rhetorical effect.

I hope this is not the case, because he does offer some useful ideas...but the constant strawmen are getting quite tiresome.

***********Again, you are asserting something that is totally wrong. It is possible to have no idea whatsoever what your caloric intake is, and lose fat mass. I can't believe you really believe this.******************

No, you are distorting what I'm saying, and, I must say it, creating another strawman.

What I AM saying is that many people refuse to accept the concept that they eat too much, and want to blame the weight gain on something else...fruit, artificial sweeteners, etc. It is these people who make some change (and the change doesn't result in a reduction in their calorie intake), and then they sit there and scratch their heads as to why they aren't losing weight. I like to use low carbers as examples because, as Mirrorball pointed out, there are many on low-carb and zero-carb forums who have hit plateaus and don't understand why they aren't continuing to lose weight. They've bought into the Taubes insulinocentric/carbohydrate viewpoint hook, line, and sinker.

Welcome Robert & THANKS! Kurt, that's how I feel in a nutshell. If you don't like what I discuss here I fail to see your purpose for reading and commenting.

I don't have the time nor desire to repeatedly set the record straight from your mischaracterizations. So a huge thanks to Sanjeev, Harry and James for carrying the water on that front.

From the very outset, in his NYT article, Taubes cites that we eat ~300 calories more now than we used to. It's some diabolical mystery as to why. He then spent 5+ years cherry picking studies to prove that it's carbohydrates that make us fat. There's no one "why" and the carb/insulin hypothesis is one of the least tenable when looked at critically. In this very post we see weight loss in the face of hyperinsulinemia.

Folks seem to be trying to find some magic thing that has caused this: The US government made us replace butter and lard with veggie oil and that made us fat. Or the food pyramid made us fat. Or low fat made us fat. Or ... I keep seeing such from people who have never been fat!

Each and every fat person knows deep down inside what made them fat and keeps them so. I happened to have figured it out for myself and try to share that stuff over at the Chronicles which is the reason I prefer to be anonymous. My hope is that someone reads something there that speaks to them and offers them a similar path. You really have no idea how amazing it is to be me these days. I have worn out a second pair of one type of jeans because I'm coming up on being the same size or slightly smaller for three freaking years. I would like to lose more, cutting carbs or eliminating nightshades (yeah, tomatoes made me fat when I was a lean kid and ate them like apples several a day from Mom's garden in season) or never having wheat flour ever again isn't the solution.

Secondly, what makes us fat is not necessarily instructive in terms of what we must do to reverse the situation. This notion that our metabolisms went wild and then we got fat just doesn't cut it for me. Sure, eliminating toxic foods and fixing micronutrient deficiencies will make us feel better, but there are several examples on the internet of - and these seem dominated by peri/post-menopausal women - folks who change their diet and experience little to no weight loss. Some even gain.

So I've said repeatedly that ELMM works every time it is tried, and I'll leave it to you all to argue the minutia. If some can eat VLC in all perpetuity and it results in the sustained decrease in intake sans any exercise to attain and maintain a normal body weight - HOORAY for you! This is the exception, however, not the rule, especially when I look at the very obese who try this WOE and keep falling off and regaining and remain convinced this is the only way to lose weight or be healthy or reverse diabetes.

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